Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB, et al.
Annals of emergency medicine. Date of publication 1995 Apr 1;volume 25(4):474-80.
1. Ann Emerg Med. 1995 Apr;25(4):474-80.
Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by
treatment with hyperbaric oxygen.
Thom SR(1), Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB.
Author information:
(1)University of Pennsylvania Medical Center, Institute for Environmental
Medicine, Philadelphia.
Comment in
Ann Emerg Med. 1995 Sep;26(3):390-2.
Ann Emerg Med. 1995 Apr;25(4):535-7.
STUDY OBJECTIVE: Carbon monoxide (CO) poisoning is a major clinical problem. The
risk of morbidity and the most effective treatment have not been clearly
established. We measured the incidence of delayed neurologic sequelae (DNS) in a
group of patients acutely poisoned with CO and tested the null hypothesis that
the incidence would not be affected by treatment with hyperbaric oxygen (HBO).
DESIGN: We conducted a prospective, randomized study in patients with mild to
moderate CO poisoning who presented within 6 hours. Patients had no history of
loss of consciousness or cardiac instability.
INTERVENTIONS: The incidence of DNS was compared between groups treated with
ambient pressure 100% oxygen or HBO (2.8 ATA for 30 minutes followed by 2.0 ATA
oxygen for 90 minutes). DNS were defined as development of new symptoms after
oxygen treatment plus deterioration on one or more subtests of a standardized
neuropsychologic screening battery.
RESULTS: In 7 of 30 patients (23%), DNS developed after treatment with
ambient-pressure oxygen, whereas no sequelae developed in 30 patients after HBO
treatment (P < .05). DNS occurred 6 +/- 1 (mean +/- SE) days after poisoning and
persisted 41 +/- 8 days. At follow-up 4 weeks after poisoning, patients who had
been treated with ambient pressure oxygen and had not sustained DNS exhibited a
worse mean score on one subtest, Trail Making, compared with the group treated
with HBO and with a control group matched according to age and education level.
There were no differences in scores between the control group and the hyperbaric
oxygen group.
CONCLUSION: DNS after CO poisoning cannot be predicted on the basis of a
patient's clinical history or CO level. HBO treatment decreased the incidence of
DNS after CO poisoning.
DOI: 10.1016/s0196-0644(95)70261-x
PMID: 7710151 [Indexed for MEDLINE]
